Provider Demographics
NPI:1275881310
Name:AIYUK, PATIENCE MAYONG
Entity Type:Individual
Prefix:
First Name:PATIENCE
Middle Name:MAYONG
Last Name:AIYUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 TERMINAL WAY STE 5
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3242
Mailing Address - Country:US
Mailing Address - Phone:775-322-0669
Mailing Address - Fax:775-424-2888
Practice Address - Street 1:1280 TERMINAL WAY STE 5
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3242
Practice Address - Country:US
Practice Address - Phone:775-322-0669
Practice Address - Fax:775-424-2888
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1275881310Medicaid